Summary points
What was already known?
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The adoption of electronic medical record systems is
► We examine the usability and appeal of a multiuser touch-screen for presenting electronic medical information to older patients. ► We found that older adults quickly adapted to the system and found it easy to use. ► Older adults suggested that having a shared view of their medical information on a shared touch-screen computer system would enhance communication.
Globally, the proportion of people over age 60 compared to younger populations is growing at a rapid rate [1]. The World Health Organization estimates that there will be 1.2 billion people over age 60 by 2025 and 2 billion by 2050. For the United States, in 2011 the first wave of the 78 million baby boomer generation will turn 65 and thus begin a two-decade period of rapid growth in the older adult population [2]. As people grow older, they typically experience an increase in health care conditions. According to the Center for Disease Control (CDC), osteoarthritis, heart disease, cancer, and diabetes are chief chronic diseases among older adults [3]. These are persistent conditions that require regular medical attention. Managing medical care is challenging for everyone, but this is particularly difficult for older adults with declining physical, visual, hearing, or cognitive abilities.
While the older generation is growing at a rapid rate, so is the prevalence of technology in health care settings, generating new challenges for older patients. A shift in computing research now places increased emphasis on understanding human interaction with computer systems rather than focusing solely on technology development. The discipline of human-centered computing encourages the design of new types of interfaces that are appropriate for the growing population of older adults and their health care needs. The introduction of computer display systems into doctor–patient interaction presents an opportunity to design and develop interfaces that suit the unique needs of older patients and improve medical communication. This article explores older adults’ perspectives on the utility and appeal of a horizontal multiuser, multitouch computer display for health care communication.
Communication about and management of one's medical care is challenging for people of all ages. Effective doctor–patient communication is tied to a variety of outcomes such as patient satisfaction, emotional health, compliance with medical recommendations, and symptom resolution [4]. Effective communication between a doctor and patient is also associated with lower rates of medical errors [5], [6]. Medical care is typically an ongoing process that involves communication among a variety of people, including doctors, nurses, specialists, lab technicians, the patient, family members, and insurance providers. Each meeting with a medical professional involves an often challenging process of information exchange frequently made more difficult because of limited time and differences in knowledge levels among participants. Emotional stress may make it particularly difficult for patients to communicate effectively or accurately remember instructions from the doctor.
The effects of aging place additional demands on physician–patient interaction [7], [8], [9], making clear and effective communication even more challenging. In fact, older patients may desire more information but receive less from physicians than younger patients [10], [11]. Ensuring that older patients receive desired medical information in an effective manner is a challenge central to the goal of this exploratory research study. Ways in which physicians can enhance communication with an older patient are for the doctor to sit face-to-face with the patient, to write down information for them, and to use charts and visuals to augment a verbal explanation [12]. Presenting digital medical records and patient information on a shared computer display has the potential to aid medical professionals and older patients in communicating more effectively.
Electronic medical records (EMRs) are changing the way medical information is managed and communicated to patients. The introduction of EMR systems and their effects on workplace practices in a medical setting is a well-studied topic within medical informatics (see [13] for a review), yet EMR systems are studied primarily with respect to use by physicians and nurses. There are only a few studies that focus on patient use such as viewing, interacting with, or helping to document one's medical history (e.g., [14], [15]).
EMRs have an impact on patients in terms of patient satisfaction [16], physician–patient interaction [17], and patient care [18]. The size and location of the computer display presenting an EMR may introduce new problems for effective communication and coordination among the physician or nurse, patient, and family or caregivers who attend the visit. For example, many exam rooms now contain a computer workstation that displays the patient's medical history. The doctor may be required to take detailed notes during the consultation, thus directing their attention toward the computer instead of the patient. An older patient who is hard of hearing may rely on lip reading and facial cues to understand spoken dialogue. Interaction is complicated when the doctor turns away from the patient to face the computer monitor. Work by Pearce et al. [19] describes body orientation of doctors and patients when computers are present in the medical interview, suggesting that some doctors and patients pay more attention to the computer than each other. Similarly, Rouf et al. [20] suggest that a computer in an exam room may have a greater effect on doctor–patient interactions involving less experienced physicians. That is, patients who saw a medical resident were more likely to report that the computer decreased interpersonal contact in the medical interview compared to patients who saw experienced physicians. While research is beginning to examine the effects of EMRs on patients, studies have yet to focus on the impact of technology in the medical interview for older patients who may be unfamiliar with or uncomfortable with such systems.
A surface computer is a large, horizontal touch-sensitive computer that allows multiple people to interact with digital media simultaneously (see Fig. 1). Unlike traditional computer workstations, touch screens do not require people to manipulate or control an input device such as a keyboard or mouse. The horizontal form factor of a tabletop allows multiple people to sit and interact simultaneously with a single computer. The large size of a surface computer provides a shared workspace where
We conducted a laboratory-based study involving 20 older adults (age 60–88; mean age = 73.4, stdev = 9.9; 13 females) to understand how this population might react to using a surface computer in a medical context. All participants came into our laboratory to participate in the study. See Table 1 for the characteristics of the sample. This study also involved 10 younger adults (age 19 to 26; mean age = 20.7, stdev = 2.2; 6 females) performing the same tasks as a benchmark to understand older adult
Results detail observations of and participant feedback regarding overall system usability, appeal of application ideas, and the perceived benefits and challenges of using this type system in a real world medical setting.
Observations and feedback from study participants indicate a range of issues that are important to consider in the design and evaluation of shared display systems aimed at supporting medical communication for older patients. First, touch interaction is extremely promising. The ease and speed at which older adults performed actions on the large touch-screen indicates that this type technology is extremely promising for interaction in a medical setting where doctors have limited time and patients
With a rapidly growing older population, expanding use of electronic medical records, and increasingly common involvement of computer technology in medical interview settings, understanding the tradeoff space of factors that influence medical communication for older patients is an important topic for both human–computer interaction and medical informatics research. This article reports results from an exploratory study involving adults age 60–88 using a prototype multiuser, multitouch surface
Piper took part in the conception and design of the study, acquisition, analysis, and interpretation of data, drafting and revising the article, and final approval of the version to be submitted. Hollan participated in the conception and design of the study, interpretation of the data, revising the article, and final approval of the version to be submitted.
There are no financial or personal relationships on part of either author that are a conflict of interest.
Research is supported by NSF grant 072901 3 and a NSF graduate fellowship. We thank our study participants, Ross Campbell for his help prototyping the application, and MERL for donating a DiamondTouch table. Study sponsors had no involvement in the study design, the collection, analysis, or interpretation of data, in the writing of the manuscript, or in the decision to submit the manuscript for publication. Summary points What was already known? The adoption of electronic medical record systems is